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VED <br /> Orda-Te 416 2"°Street Phone:(209)744-0112 <br /> 1 {i a�+ Galt,Ca 95632 Fax:(zo9)7a4 ou6 APR70 7 014 <br /> affords often <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and Understanding of and Compliance with UST Re uirementFNViRONMENTAL HEALTH <br /> Facility Name: Quick;Kleen Car Wash Facility#: PO# <br /> Address: 707 F Yosemite Ave Manteca CA Z Updated Owners Statement n <br /> Facility Phone#:209-670-6473 ❑Change of Designated Operator <br /> 0 New utsirnated Operator <br /> DESIGNATED UST OPERATOR FOR TRIS FACII.ITY-. <br /> PRLMARY, _N <br /> Designated Operator's Name: ZANE NIMMO Service Technician <br /> Business Name: AFFORDA TEST ICC#: 5263322-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/3/16 <br /> ALTERNATEI <br /> Designated Operator's Name: FELIX RAMIREZ Service Technician <br /> Business Name: AFFORDA TEST ICC#: 52733934-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/3/16 <br /> ALTERNATE 2 <br /> Designated Operator's Name: DAVID WINKLER Service Technician <br /> Business Name: AFFORDA TEST ICC#: 5263373-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/10116 <br /> ALTERNATE3 <br /> Designated Operator's Name: EDWARD STEARNS Service Technician <br /> Business Name: AFFORDA TEST ICC#: 5250492-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/3116 <br /> I certify that,for the facility indicated at the top of this page,the Individuals listed above will some as Designated UST <br /> Operators. The individuals will conduct and document monthly facility Inspections and annual facility employee <br /> training,in <br /> Accordance with California Code of Regulations jitle23,wi o-q 2915(el l( — <br /> FwtMrmxw i wsus", sad sad am in eempgaeee with the requirsmeatttamtatas,rt;wltdfona,and local <br /> oardi/aads) spo"W to andergroand storage tanks, <br /> NAME OF TANK OWNER/Operator Mriaty.Van de lEnWImsesine <br /> SIGNATURE OF TANK OWNE170perator� <br /> DATE: 7 1 q __ oWN£RS PRO,- t <br /> raotcr <br /> 1)StJ164i1t TIAS L"Os8L6TBD VOM TO 7?iC LOCAs.AGENCY U'/tYC awaC>ey AF'rta 510NING.1W LOCAL <br /> AOV4CV Li01'is AVAUAe&LS AT,WIV <br /> 2) NcsIWY T"LOCAL AG0%NCY ANY ti9 Taw tNFOBMATtON 30 VAYS Of Tut <br /> CHANGF— <br /> ,,yy <br /> OF�Cnt) Date Faxed Ll ��,s DateStsanad: <br /> 5 Dais E-Maihtd <br />